Go Ahead. Vaccinate the Kids.

The risk of vaccinating children will never be zero, but the alternative is so much worse.

Vaccine needle and vial
Brett Carlsen / The N​ew York Times / Redux

About the author: Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine.

It’s easy to argue for vaccinating adults and teenagers against COVID-19. Some think it’s harder to make the case for kids under 12 years of age, and for understandable reasons. Much of the world remains unvaccinated, kids have generally been much less affected by the coronavirus, and we don’t yet have a thorough understanding of the risks versus the benefits. Still, if we weigh all the pros and cons, the argument for immunizing young children is much stronger than the argument against.

Let me start with the most compelling argument not to vaccinate kids: the international ethical one. Adults all over the world are at much greater risk than American children, and our doses could theoretically go somewhere else. That’s true. Unfortunately, doing so would require cooperative action not yet seen in the United States. Our doses tend to remain our doses, and there’s no major effort to disseminate them globally in a more equitable manner. Given that, using those vaccines to immunize the 48 million American children under 12 who are completely unvaccinated—and at continued risk from COVID-19—is the best way to provide significant benefits to everyone, limit the spread of the virus, and prevent future variants from developing here.

Those opposed to vaccinating younger kids argue that the potential harms outweigh the benefits of immunization. They point out that kids might not see as much of an advantage from vaccination as adults do, and that they might experience side effects older adults don’t, as young adults seem to with myocarditis. They remind us that the real worry in the spring of 2020, when we closed down schools across the country, wasn’t that children were likely to become seriously ill. It was that they might be a vector for infecting their parents or, worse, their grandparents. The overwhelming majority of elderly Americans are now vaccinated.

But last fall, as many schools went online or hybrid, it became apparent that while kids were at reduced risk, that risk was real. At least 354 kids have died from COVID-19. Many more thousands have been hospitalized. More than 4,400 have been diagnosed with multisystem inflammatory syndrome in children (MIS-C), a “rare but serious condition associated with COVID-19,” and many more have been ill, even if they’ve recovered pretty well. Although COVID-19 has been nowhere near the danger that it has posed to adults and the elderly, it’s still been worse than most flu seasons for children.

The Delta variant’s predominance has further complicated the discussion. Last year, one could argue that kids were less likely to get infected than adults, less likely to transmit disease if they did, and less likely to be symptomatic as well. That’s no longer clear. Because Delta is so much more infectious, children seem to be getting sick in larger numbers. Pediatric wards are more crowded, especially in areas of low vaccination, and there’s renewed concern that schools could become centers for outbreaks this fall.

True, all these arguments could be made to get more adults vaccinated, reducing the risk to the young as well as the old, but efforts to do that have stalled across the country. In light of this reality, vaccinating kids would still slow down community transmission.

And that’s a bigger reason to immunize children—to protect those who cannot protect themselves.

In the late 1990s, when the varicella vaccine was still new, I was a young pediatrician. I spent a lot of time persuading parents to immunize their children against chicken pox. They would argue that the disease was mild, not a big deal, and that the risks of the shot outweighed the benefits. The disease wasn’t mild for everyone, though. It posed a significant risk to adults who’d never had it. It also posed a risk to babies.

Even though we couldn’t vaccinate kids until their first birthday, by vaccinating those who were older, we began to prevent nearly all infant deaths from varicella. Vaccinating kids made others safer. Even if children themselves are at lower risk, they’re still part of our shared humanity, and immunizing them will help to protect society as a whole.

It doesn’t have to be that abstract, though—and shouldn’t be, if it’s going to be a persuasive public-health message. Nearly all children have grandparents. Those grandparents are best protected by being vaccinated themselves, but they remain at risk from breakthrough infections, which become more likely the more they’re exposed to COVID-19. Many children have loved ones with cancer or other immunological disorders that also place them at higher risk. Many children have such disorders themselves.

Vaccinating children to protect those they love shouldn’t be a hard decision.

My kids (15, 17, and 19) are no longer that young, and they’re all immunized. I have no doubt that if they were younger, though, my wife and I would still vaccinate them as soon as they were eligible. Vaccinations are arguably the greatest public-health achievement of the past century, a fact that’s only become more obvious in the past year. They’re a collective good, and as part of society, we should honor the social contract to protect others as we’d want to be protected ourselves.

Of course, all of this depends on the FDA authorizing the vaccines for younger children. That could happen before the end of this year. It will take longer to monitor for rarer side effects as doses start to be delivered in large numbers, which means that mandates for kids in school might take more time after that.

After examining this issue from all angles, as a parent I’m confronted with this: As variants become more and more infectious, we face the reality that nearly everyone is likely to get COVID-19 at some point unless they’re vaccinated. Even for kids, the latter is so, so much better than the former. That makes the decision pretty easy. For the sake of everyone, we need to start vaccinating younger children as soon as possible.